Description / Abstract:

Main purpose

The purpose of this International Standard is to establish a nursing reference terminology model consistent with the goals and objectives of other specific health terminology models in order to provide a more unified reference health model. This International Standard includes the development of reference terminology models for nursing diagnoses and nursing actions and relevant terminology and definitions for its implementation.

The potential uses for this reference terminology model are to

• support the intensional definition of nursing diagnosis and nursing action concepts reflective of a broad range of roles and practice settings,

• facilitate the representation of nursing diagnosis and nursing action concepts and their relationships in a manner suitable for computer processing,

• provide a framework for the generation of compositional expressions from atomic concepts within a reference terminology,

• facilitate the construction of nursing terminologies in a regular form which will make mapping among them easier,

• facilitate the mapping among nursing diagnosis and nursing action concepts from various terminologies including those developed as interface terminologies and statistical classifications,

• enable the systematic evaluation of terminologies and associated terminology models for purposes of harmonization, and

• provide a language to describe the structure of nursing diagnosis and nursing action concepts in order to enable appropriate integration with other reference terminology models and with information models.

Target groups

The target groups for this International Standard are

• developers of coding systems and terminologies that include nursing diagnosis and nursing action concepts, to assist in the development, refinement, and maintenance of a particular terminology, as well as for comparisons among different systems,

• developers of reference terminology models for other health-care domains, to explicate the relationships and overlap with nursing concepts,

• information modellers, knowledge engineers, and standards developers building models for healthinformation management systems such as electronic health records and decision support systems, to describe the expected content of terminological value domains for particular attributes and data elements in the information models,

• developers of information systems that require an explicit system of concepts for internal organization, data warehouse management and middleware services,

• developers of software for natural language processing, to facilitate harmonisation of their output with coding systems, and

• developers of mark-up standards for representation of health-care documents.

Topics considered outside scope

Topics considered outside the scope of this International Standard include

• descriptors and guidelines to represent contextual information for the recording of information within an electronic health record, • an exhaustive list of all the potential details that could appear in expressions of nursing diagnoses and nursing actions, • an exhaustive thesaurus with the complete list of descriptors to be used to describe nursing diagnoses and nursing actions, • relationships among health professionals, and • communication of nursing diagnosis and nursing action concepts between electronic health records.